A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder

NURS-6630 Week 5: Assignment De-Prescribing – A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder

What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 5- to 6-page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course.

Note: APA style format guidelines will apply.

Patient Example:

Patient 3: A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective.

The Assignment – A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder

Answer the following questions using the patient example described above.

Patient 3 

  • Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.
  • Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum.
  • The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.
  • The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus.

Patient 3 – SOLVED – A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder

The case of the 24-year-old pregnant woman prescribed Lorazepam for generalized anxiety disorder presents a complex clinical scenario that needs careful outweigh for the risks and benefits of the mother and her fetus. In their study, Wang et al. (2022) prescribing BZDs and z-drugs during pregnancy needs a careful balance of potential benefits against the risks of adverse obstetric and neonatal outcomes and extensive long-term consequences for the child’s growth and development. To reduce the risk associated with abrupt Lorazepam withdrawal, it is essential to utilize a gradual tapering to discontinue Lorazepam or lower the dosage slowly. In their study, Reid Finlayson et al. (2022) noted that lorazepam treatment should be discontinued gradually and with a reduction of about 0.125 mg BID every three days until the drug becomes wholly withdrawn.

ORDER YOUR PAPER HERE

As part of patient education, it is essential to emphasize the benefits of gradual reduction and not abrupt stopping. The patient will be educated on the impact of abrupt withdrawal of lorazepam, including withdrawal reactions such as blurred vision, insomnia, sweating, and seizures. It is essential to educate the patient that the cessation of treatment using benzodiazepines may make the patient distressed physiologically due to the physical dependence and potential for withdrawal, such as seizures (Maust et al., 2023). It is essential to consider the risks associated with untreated anxiety during pregnancy. Having untreated anxiety during pregnancy is a significant risk factor for postpartum depression and may affect the child’s development and the maternal-infant bonding. Severe maternal anxiety has been associated with adverse outcomes such as preterm birth, low birth weight, and possible outcomes to fetal neurodevelopment.

References

Maust, D. T., Petzold, K., Strominger, J., Kim, H. M., & Bohnert, A. S. (2023). Benzodiazepine Discontinuation and Mortality Among Patients Receiving Long-Term Benzodiazepine Therapy. JAMA network open, 6(12), e2348557-e2348557. https://doi.org/10.1001/jamanetworkopen.2023.48557

Reid Finlayson, A. J., Macoubrie, J., Huff, C., Foster, D. E., & Martin, P. R. (2022). Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. Therapeutic advances in psychopharmacology, p. 12, 20451253221082386. https://doi.org/10.1177/20451253221082386

Su, Y., Dong, J., Sun, J., Zhang, Y., Ma, S., Li, M., … & Zhu, P. (2021). Cognitive function assessed by Mini-mental state examination and risk of all-cause mortality: a community-based prospective cohort study. BMC geriatrics, 21, 1–10. https://doi.org/10.1186/s12877-021-02471-9

Wang, X., Zhang, T., Ekheden, I., Chang, Z., Hellner, C., Hasselström, J., … & Sidorchuk, A. (2022). Prenatal exposure to benzodiazepines and Z-drugs in humans and risk of adverse neurodevelopmental outcomes in offspring: A systematic review. Neuroscience & Biobehavioral Reviews, 137, 104647. https://doi.org/10.1016/j.neubiorev.2022.104647